Indirect airway challenges

GF Joos*, B O'Connor, SD Anderson, F Chung, DW Cockcroft, B Dahlen, G DiMaria, A Foresi, FE Hargreave, ST Holgate, M Inman, J Lotvall, H Magnussen, R Polosa, DS Postma, J Riedler, ERS Task Force

*Corresponding author for this work

    Research output: Contribution to journalReview articlepeer-review

    309 Citations (Scopus)

    Abstract

    Indirect challenges act by causing the release of endogenous mediators that cause the airway smooth muscle to contract. This is in contrast to the direct challenges where agonists such as methacholine or histamine cause airflow limitation predominantly via a direct effect on airway smooth muscle.

    Direct airway challenges have been used widely and are well standardised. They are highly sensitive, but not specific to asthma and can be used to exclude current asthma in a clinic population. Indirect bronchial stimuli, in particular exercise, hyperventilation, hypertonic aerosols, as well as adenosine, may reflect more directly the ongoing airway inflammation and are therefore more specific to identify active asthma. They are increasingly used to evaluate the prevalence of bronchial hyperresponsiveness and to assess specific problems in patients with known asthma, e.g. exercise-induced bronchoconstriction, evaluation before scuba diving.

    Direct bronchial responsiveness is only slowly and to a modest extent, influenced by repeated administration of inhaled steroids. Indirect challenges may reflect more closely acute changes in airway inflammation and a change in responsiveness to an indirect stimulus may be a clinically relevant marker to assess the clinical course of asthma. Moreover, some of the indirect challenges, e.g. hypertonic saline and mannitol, can be combined with the assessment of inflammatory cells by induction of sputum.

    Original languageEnglish
    Pages (from-to)1050-1068
    Number of pages19
    JournalEuropean Respiratory Journal
    Volume21
    Issue number6
    DOIs
    Publication statusPublished - Jun-2003

    Keywords

    • EXERCISE-INDUCED ASTHMA
    • BRADYKININ-INDUCED BRONCHOCONSTRICTION
    • ADENOSINE-INDUCED BRONCHOCONSTRICTION
    • LEUKOTRIENE-RECEPTOR ANTAGONIST
    • OBSTRUCTIVE PULMONARY-DISEASE
    • METHACHOLINE-INDUCED BRONCHOCONSTRICTION
    • HYPERTONIC SALINE CHALLENGE
    • NEBULIZED DISTILLED WATER
    • LONG-TERM TREATMENT
    • METABISULFITE-INDUCED BRONCHOCONSTRICTION

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